Diagnosis of and screening for hypothyroidism in nonpregnant adults
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
The diagnosis of hypothyroidism relies heavily upon laboratory tests because of the lack of specificity of the typical clinical manifestations. Primary hypothyroidism is characterized by a high serum thyroid-stimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration, whereas subclinical hypothyroidism is defined biochemically as a normal free T4 concentration in the presence of an elevated TSH concentration. Secondary (central) hypothyroidism is characterized by a low serum T4 concentration and a serum TSH concentration that is not appropriately elevated.
This topic will review diagnosis of and screening for hypothyroidism in nonpregnant adults. Screening for hypothyroidism during pregnancy and in neonates is reviewed separately. (See "Hypothyroidism during pregnancy: Clinical manifestations, diagnosis, and treatment", section on 'Screening' and "Clinical features and detection of congenital hypothyroidism", section on 'Newborn screening'.)
The major clinical manifestations, causes, and treatment of hypothyroidism, and the diagnosis and management of subclinical hypothyroidism are discussed separately. (See "Clinical manifestations of hypothyroidism" and "Disorders that cause hypothyroidism" and "Treatment of primary hypothyroidism in adults" and "Subclinical hypothyroidism in nonpregnant adults".)
In community surveys, the prevalence of overt hypothyroidism varies from 0.1 to 2 percent [1-5]. The prevalence of subclinical hypothyroidism is higher, ranging from 4 to 10 percent of adults, with possibly a higher frequency in older women [1,2,6,7]. However, there is an age-related shift towards higher thyroid-stimulating hormone (TSH) concentrations in older patients and, therefore, if age-adjusted normal ranges are used, the prevalence may not increase with old age. (See "Laboratory assessment of thyroid function", section on 'Serum TSH concentration'.)
Hypothyroidism is five to eight times more common in women than men, and more common in women with small body size at birth and during childhood [5,8].
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- CLINICAL FEATURES
- Primary hypothyroidism
- Secondary and tertiary (central) hypothyroidism
- DIFFERENTIAL DIAGNOSIS
- Resistance to TSH or thyroid hormone
- Nonthyroidal illness
- Thyrotropin-secreting pituitary adenomas
- IDENTIFYING THE CAUSE
- Thyroid peroxidase antibodies
- Candidates for screening
- Screening tests
- Recommendations by expert groups
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS